0001672926-16-000003.txt : 20161228 0001672926-16-000003.hdr.sgml : 20161228 20161228143236 ACCESSION NUMBER: 0001672926-16-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161228 DATE AS OF CHANGE: 20161228 EFFECTIVENESS DATE: 20161228 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Providence Medical Technology, Inc. CENTRAL INDEX KEY: 0001672926 IRS NUMBER: 208458569 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-277153 FILM NUMBER: 162072318 BUSINESS ADDRESS: STREET 1: 3650 MT. DIABLO AVENUE STREET 2: SUITE 104 CITY: LAFAYETTE STATE: CA ZIP: 94549 BUSINESS PHONE: 415-425-4961 MAIL ADDRESS: STREET 1: 3650 MT. DIABLO AVENUE STREET 2: SUITE 104 CITY: LAFAYETTE STATE: CA ZIP: 94549 D 1 primary_doc.xml X0707 D LIVE 0001672926 Providence Medical Technology, Inc. 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 415-425-4961 CALIFORNIA None None Corporation true Bruce McCormack, MD 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Director Jeffrey D. Smith 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Executive Officer Director Arthur Taylor 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Director Bruce McCormack 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Director Bruce McCormack 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Director James Hens 1331 N. California Blvd. Suite 320 Walnut Creek CA CALIFORNIA 94596 Director Evan Ng 305 Lytton Avenue Palo Alto CA CALIFORNIA 94301 Executive Officer Other Decline to Disclose 06b false 2016-12-14 false true false 0 8160000 6999998 1160002 Series F Preferred Stock Financing false 2 0 0 0 false Providence Medical Technology, Inc. /s/ Evan Ng Evan Ng Secretary 2016-12-28